Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems

Abstract

Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.

Emerging Palliative Care Innovations in the ED: A Qualitative Analysis of Programmatic Elements During the COVID-19 Pandemic

“…Over 20 physicians, primarily internists, family physicians and pediatricians whose clinical demands had decreased due to COVID, completed a training leveraging the Serious Illness Conversation Guide. 20 These clinicians were paired with a 'psychosocial partner' with a background in social work or child-life. This dyad was fully embedded in the ED with a formal process for accessing PC physician support as needed.…”

A dimensional analysis of inner strength in people ageing with serious illness

“…Attitudes and agendas are expressed during healthcare communication, which may block or facilitate inner strength (Thorne, 2006). Exploring how attitudes are conveyed via spotlighting during these conversations may further inform communication paradigms that influence nursing practice (Paladino et al, 2020).…”

CODE: a practical framework for advancing patient-centred code status discussions

“…Effective education methods have been described including simulation-based classroom training. 14 Upfront investment in training appears to be long lasting, with proficiency retained at 1 year. 15 Broadbased training is needed with prioritisation of hospital admitting clinicians (trainees and attending physicians), intensive care unit nurse staff and specialty physicians who serve as the primary longitudinal care providers for the highest risk patient populations (eg, primary care, cardiology, oncology, geriatrics).…”